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Providers Contracting With Medicare Plans Must Certify They Are Meeting Compliance Training Requirements

Publications - Client Alert | December 17, 2015,

Effective January 1, 2016, physician groups and providers that have contracted with Medicare Advantage Plans or Medicare Prescription Drug Benefit Plans (“Sponsors”) are now being asked by these plans to certify that they are meeting certain compliance training requirements.

On May 23, 3014, the Centers for Medicare and Medicaid Services (“CMS”) published Medicare Program; Contract Year 2015 Policy and Technical Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs (the “Final Rule”). This Final Rule revised and clarified various provisions of the Medicare Advantage (“MA”) program (Medicare Part C) regulations and the prescription drug benefit program (Medicare Part D) regulations.

The  Final Rule requires that Sponsors now require each of their “First Tier, Downstream or other Related Entities” (collectively, FDRs) to either complete the CMS module for general compliance training and the CMS module for fraud, waste and abuse training, or incorporate these modules into existing compliance training.

In order to comply with the Final Rule, Sponsors must ensure that their FDRs (including employees of the FDRs) have satisfied both general compliance and fraud, waste and abuse training requirements that must be completed 90 days after initial hire/contracting and annually thereafter.

Sponsors have two options for ensuring compliance by FDRs:

  1. FDR employees can individually complete a general compliance and/or fraud, waste and abuse training modules located on the CMS Medicare Learning Network (“MLN”). Once this individual training is complete, the system will generate a certificate of completion. A certification of completion must be provided for each of the FDR’s employees. The MLN certificate of completion must be accepted by all Sponsors.
  2. FDRs may download, view or print the content of the CMS standardized training modules from the CMS website to incorporate into their existing compliance training programs. The CMS training content cannot be modified, but organizations are free to add additional training topics and information specific to their organization. If this method is used, FDRs must provide Sponsors with an attestation confirming that the organization has completed the appropriate general compliance training and fraud, waste and abuse training. CMS will accept these attestations as an alternative to the MLN system-generated certificates of completion.

Sponsors and FDRs must maintain certificates or documentation of training completion and furnish upon request certificates of training. Such documentation must include, at minimum, employee names, dates of employment, dates of completion, and passing scores (if captured) to clearly document training completion.

As Sponsors are required to validate that all the compliance training requirements are completed by their FDRs, many Sponsors now require their FDRs to execute statements of attestation, verifying that the FDRs have either completed the MLN training modules or incorporated unmodified CMS training into their own compliance training programs.

Additional Information

This Client Alert provides an overview of the compliance training requirements for physician groups and providers that have contracted with the Medicare Advantage Plans or Medicare Prescription Drug Benefit Plans. If your organization has questions related to these issues, please contact your Kutak Rock attorney, one of the authors of this Alert listed below, or a member of our National Health Care Group.